Regulation on smoke-free products is now on the front burner following the Warsaw Poland conference of Global Forum on Nicotine (GFN).
The picture that went round at the 10th-year anniversary of GFN is that of human rights violation on the right for choices and denial of freedom of association.
The conference which witnessed serious debate on vaping and the right for choices has charted a way forward for the next decade in a world that is moving towards smoke-free products.
Various speakers frowned at the lack of right of choices for all, with some countries already enacting laws that are against smoke-free products, thereby limiting the right to choices.
LEADERSHIP Weekend gathered that multinational companies including Philip Morris International (PMI) are spending billions on research on the efficacy of smoke-free products that will be rampant by 2025.
But speaking at a workshop on reducing the environmental impacts in tobacco-harm reduction in the ongoing conference in Poland, an Australian physician and academician, Dr Colin Mendelsohn said the concerns about vaping are being used to further justify opposition to tobacco-harm reduction.
Also, the director of Bay Pharma, David Burns, said disposable vapes do cause environmental impacts adding that landfill fires have occurred in Australia when compactors crushed unstable lithium on batteries which have ignited.
The managing director of Idwala Research, Pieter Vorster, said the safer nicotine product industry has focused on making the best possible product for the consumer.
“Now, issues of sustainability have to be addressed, such as lithium as a finite resource,” Vorster said, agreeing that the environmental impact of vaping and safer nicotine products must be considered in comparison with the far greater impact of smoking, from land use to cigarette waste.
A consumer advocate from Mexico, Juan José Cirión, said people must understand that consumers have the right to choices, insisting that products that are less harmful should be introduced.
“Consumers need access to information, access to products and access to choices,” he said.
President of ASOVAPE, a company based in Costa Rica, Jeffrey Zamora, said though the COP10 is hoping to meet from November 25-26 in Panama, people’s right must be considered.
“Historically, we know that access to this conference has been denied and consumers have been refused permission to participate. We should be allowed to claim our rights to harm reduction,” he said.
Also, the president of ARDT Iberoamérica Francisco Ordóñez said they must request their countries to allow consumers to discuss and share ideas.
“Ahead of COP10 in Panama, it is important that we request that our countries allow (consumers) to talk. Delegations should invite their citizens – including consumers – to participate.
“Although we will probably be told it is not possible, we must ask. It is also important that the COP10 delegations ask other countries, like Sweden and the United Kingdom, to share evidence on how tobacco-harm reduction is working for their populations,” he said.
But looking at the medicinal licensing of vaping products and the potential implications for public health, an international fellow of the Taxpayers Protection Alliance, Martin Cullip, said he is vaping and not ill.
“I’m a (vape) consumer and when I was a smoker, I wasn’t ill, and I didn’t need treatment. Prescription vapes are a good idea, but I know consumers have a lot of reservations about them.
“There is this mistrust that once you get prescription vapes, the push will be towards getting rid of the consumer market entirely and having just the prescription route. I know this is something consumers are very worried about.”
“The prescription model doesn’t deal with the fact that many vapers who are former smokers, including me, were accidental quitters. I never made a single quit attempt in my life. I tried a vaping product to see what it was like and I then just forgot to smoke over a number of years.
“Some smokers wouldn’t consider prescription vapes as a smoking cessation tool and if we did end up with no consumer market, then people like me wouldn’t have quitted,” he said.
Mark Dickinson who owns Clarityse Ltd, an independent strategic marketing consultancy with experience across the over-the-counter medicines and vaping sectors asked to know why prescription vapes are necessary.
“Why have prescription vapes? It comes down to choice and variety. I think there are smokers out there who would access this market and the perceptions of the quality, efficacy and science behind a medical endorsement (for prescription vapes) will give them more confidence. For those who are open to medical support, there’s a significant number of them who will be interested in prescription vapes. So, I think there is a market for it.
“I think the people who are nervous about this are nervous because they see the whole market being driven into the medicinal end, and the death of the consumer segment. If I believed that was the case, I would switch my view entirely, but I don’t think that will happen, at least in the UK. Whilst 10 years ago the public health community were advocating for a prescription model (for vaping), I think they’ve changed their view entirely and I think that they would acknowledge that it would be a disaster from a public health point of view if the whole market shifted (to prescription vapes). It would destroy the whole market and what’s going on in Australia is evidence to demonstrate that that’s just a disastrous policy,” he said.
A physician and public health scientist at Brown University in the US, Jasjit Ahluwalia said the biggest thing about the prescription model is the word ‘choice.’
“There should be a whole gamut of choices out there, whatever is available that reduces the harm of one of the deadliest products on earth which is the combustible cigarette.
“With regard to the role of physicians, they are ridiculously busy. They like to give people medications and solve problems through medications. Right now, published research shows that 85 percent of US-based physicians think that nicotine causes cancer which is unbelievable. It does not cause cancer. Also, a very large number of them, 65 or 70 percent, think e-cigarettes were as dangerous or more dangerous than cigarettes. There is no way that they are as or more dangerous than combustible cigarettes. Physicians are currently very anti-vaping in the US, but if something was medically licensed, all of a sudden, they would buy into it.
“I was a late adopter to e-cigarettes. I didn’t buy into them at first, but I converted over the last couple of years, and I think it’s the biggest game changer I’ve seen in my 30 years of doing work in smoking. We still say in the United States that 450,000 Americans die of tobacco every year. That’s exactly what I said in 1992. It’s a tragedy,” he added.
On questions whether health professionals have a moral and ethical duty to promote harm reduction, the co-founder of the Latin American Network on Tobacco Harm Reduction (RELDAT), Enrique Terán said people are stigmatised because they support harm reduction publicly.
“If you support the topic of harm reduction publicly, you’re immediately stigmatised, you’re attacked, you’re pointed at. This means that most professionals, even if they might be in favour of this movement, decide not to say so.”
On his part, the spokesperson for RELDAT, Diego Verrastro, said doctors must accept that they are in an era of change.
“As doctors, we are in an era of change where we are creating history. When we study medicine, we study Fleming with penicillin. Will the future look at us in that way? Because we’re making history; because we’re doctors; because we want to save lives; because we don’t want to damage people. And sometimes politicians struggle to understand this,” he added.
There have been serious concerns on legislation and in particular, the issue of flavours in vaping products.
The head of Philippines’ Department of Energy’s Financial and Legal Services, who was co-author of the Vapourised Nicotine and Non-Nicotine Products (VNNP) Act 2022, Undersecretary Sharon Garin, said objectives were firstly for minors not to consume vapourised nicotine and non-nicotine products and secondly for current smokers to adopt a less harmful habit.
“If we removed flavours, that might affect the adults who were already smokers. They want more options when they decide to switch to a less harmful product. So, the stance was to reduce the attractiveness of these products to minors. For instance, it’s prohibited to have packaging which is attractive to children. So, cartoon characters are not allowed.
“The second point is to keep the flavours so that those who opt to switch (from cigarettes) to a healthier product have more options available. While the flavours are not restricted, the way you can name them is. So, they cannot have flavours with names such as bubble gum that might attract children. It was not easy to formulate (this legislation) but that was how we balanced it and I think all the stakeholders were quite satisfied with the outcome,” he said.
A cardiologist, Dr Rafael Castillo, said he was the late star which aligned with the universe with regards to the vaping law.
“We really wanted to make sure that we were making the right recommendation and I must make a confession. Initially, I had some misgivings about e-cigarettes as a solution as we were well aware of the big scare regarding EVALI. But we decided you should not throw the baby out with bath water, and we wanted to do our own research to see if these products could help us achieve what we wanted.
“And, after conducting studies ourselves, we were convinced that, although more data were needed, the use of VNNPs was definitely less harmful than smoking combustible cigarettes and could be considered to be a pragmatic middle ground to which we should bring our current adult cigarette smokers.
“I am also quite confident that with regulations and the taxation of vaporized nicotine and non-nicotine products, you could get a positive bottom line for the government. This is because the taxation of VNNPs is not like the former excise taxes for cigarettes, what we call the sin taxes. Although the government collected something like 130 billion in excise taxes, they were spending 210 billion treating the complications of those who smoke, so the bottom line was negative. I hope with the VNNP law we can expect a more positive bottom line, with more revenues, but less government expense treating the complications caused by the use of these alternative products.”
The president of Quit For Good, a non-profit organisation promoting harm reduction to mitigate the damage caused by cigarettes, Dr Lorenzo Mata said what pushed congress to pass the law is because they listen to the people.
“We have over one million vapers in the Philippines, and according to the latest survey, 19.5 percent of Filipinos are current tobacco users. That is one out of five Filipinos. I have been a doctor for over 40 years, and I know how difficult it is for smokers when they have no alternatives that are less harmful,” he said.
Pundits believed that the Tobacco industry transformation is reaching low and middle-income countries.
The co-founder of the Centre for Health Research and Education, an organisation that addresses the needs of the most disadvantaged tobacco users, Dr Sud Patwardhan said his team of over 100 medical and public health experts works in cancer prevention in the UK and South Asia stating that consumers all around the world are demanding reduced risk products from tobacco.
“They may not express it all around the world but that unexpressed mood is very strong, and it is also a fact that most tobacco companies have significant revenue and profit source from low-and-middle-income countries. If you look at India or Indonesia, or many countries in Africa, many countries in South America, (these countries are) big sources for tobacco companies for revenue and profit. And the other factor is that, of course, there are the FCTC (Framework Convention on Tobacco Control) guidelines, but these countries have limited capacity or capability to enforce those guidelines. So, there is a bit of regulatory uncertainty which also impacts commitment from the tobacco companies,” he said, adding that the smoke-free products would go a long way.